Thursday, March 29, 2012

The Afternoon Drill: March 29, 2012

About one in 88 children in the United States has autism or a related disorder, the highest estimate to date and one that is sure to revive a national argument over how the condition is diagnosed and treated.

The estimate released on Thursday by the Centers for Disease Control and Prevention represents an overall increase of about 25 percent since the last analysis in 2006 and a near-doubling of the rate reported in 2002.

Among boys, the rate of autism spectrum disorders is one in 54, almost five times that of girls, in whom the rate is one in 252.

"One thing the data tells us with certainty - there are many children and families who need help," CDC Director Thomas Frieden said at a press conference.

The reported spike in the prevalence of autism and related disorders raised questions about whether it is real or an artifact of greater awareness that has led parents, teachers, and even health-care providers to see symptoms of autism in children who would not have received the diagnosis a generation ago.

If it is real, that suggests that some change in the environment might be responsible. In recent years suspicion has focused on everything from mercury, a known neurotoxin, in air and food, to the increasing age of new mothers and fathers.

There is a good possibility that much of the reported increase in the prevalence of autism is illusory, however. When asked about this during the news conference, CDC's Frieden pointed out that "doctors have gotten better at diagnosing the condition and communities have gotten better at providing services, so I think we can say it is possible that the increase is the result of better detection."

Sherri Meek, executive director of the Texas State Board of Dental Examiners since 2007, resigned earlier this month and will not be present at an April legislative hearing where board critics plan to testify.

Meek, who cited personal reasons for her resignation, is using up personal leave time before her resignation takes effect Aug. 31, said the board's general counsel, Joy Sparks.

Glenn Parker, former executive director of the Texas Board of Chiropractic Examiners, has been the agency's director of administration for the past several months and has taken over as acting executive director with a salary of $75,000, a $5,000 increase to cover his additional duties, according to a March 12 letter Meek wrote to Parker.

Parker will be at the House Public Health Committee hearing at 10:30 a.m. April 11 in the Capitol Annex, E2.012. It is open to the public.

The committee will hear public testimony about various state health registries and concerns about the dental board, including its enforcement practices and a law that allows board members to act as expert witnesses in cases involving dentists, as long as the board does not object.

"No board member has ever asked for permission to serve as an expert," Sparks said, adding that she "would have absolutely no problem" with a law banning it.

Members of the Houston-based Texans for Dental Reform said they plan to speak at the hearing and voice concerns about what they called uneven and discriminatory enforcement of the dental practice laws, "overemphasis on protection of dentists" and conflicts of interest.

The demand for dentist anesthesiologists in pediatric dental practices is on the rise. More than 70 percent of board-certified pediatric dentists in the United States provide mild to moderate sedation in their practices. Nearly that many, 60 to 70 percent, would use a dentist anesthesiologist if one were available. However, supply cannot yet meet the demand.

The current issue of the journal Anesthesia Progress reports on two congruent surveys, one of board-certified pediatric dentists and one of directors of pediatric dentistry and dental anesthesiology training programs. These surveys explore models of office-based dental sedation and future needs for deep sedation and general anesthesia services in pediatric dentistry.

As much as 12.3 percent of the general U.S. population has been reported to experience dental fear and anxiety. Among junior high and secondary school students, about 18 percent reported moderate dental fear. This is one of the reasons behind the increased need for sedation in dental practices.

Extensive treatment needs, anxiety, uncooperative but age-appropriate behavior, and limited cognitive functioning are among causes that require deep sedation or general anesthesia for young dental patients. Two-thirds of pediatric dentistry residency directors anticipate this need for dental anesthesiology services to increase in coming years. Among dental anesthesiology program directors, 88 percent report increased requests for anesthesiology services by pediatric dentists over the past 10 years.

Half of all cancers could be prevented if people just adopted healthier behaviors, US scientists argued on Wednesday.

Smoking is blamed for a third of all US cancer cases and being overweight leads to another 20 percent of the deadly burden that costs the United States some $226 billion per year in health care expenses and lost productivity.

For instance, up to three quarters of US lung cancer cases could be avoided if people did not smoke, said the article in the US journal Science Translational Medicine.

Science has shown that plenty of other cancers can also be prevented, either with vaccines to prevent human papillomavirus and hepatitis, which can cause cervical and liver cancers, or by protecting against sun exposure, which can cause skin cancer.

Society as a whole must recognize the need for these changes and take seriously an attempt to instill healthier habits, said the researchers.